Consent for Treatment
I understand that there are medical risks associated with the procedure, including, but not limited to infection, hemorrhage, allergic reaction, anesthetic drug reaction, anesthesia-induced cardiac compromise, and possible death. I understand that the doctor will perform a physical exam, but not perform a comprehensive cardiac exam, other diagnostic tests, or blood work prior to procedure. Furthermore, I authorize RMAA in an emergency situation, to follow through with such procedures as necessary for the wellbeing of my pet on a continuing basis until further communication with me. I will hold harmless Rozzie May Animal Alliance, its officers, directors, veterinarians, technicians, volunteers, and agents for any problems experienced by the animal as a result of the procedure or the unknown risk factors. I assume all risks.
I understand that there are medical risks associated with the procedure, including, but not limited to infection, hemorrhage, allergic reaction, anesthetic drug reaction, anesthesia-induced cardiac compromise, and possible death. I understand that the doctor will perform a physical exam, but not perform a comprehensive cardiac exam, other diagnostic tests, or blood work prior to procedure. Furthermore, I authorize RMAA in an emergency situation, to follow through with such procedures as necessary for the wellbeing of my pet on a continuing basis until further communication with me. I will hold harmless Rozzie May Animal Alliance, its officers, directors, veterinarians, technicians, volunteers, and agents for any problems experienced by the animal as a result of the procedure or the unknown risk factors. I assume all risks.
The presence of a heart murmur can put my pet at an increased risk for anesthesia and surgical complications. RMAA will perform surgery on animals with a slight heart murmur at the attending doctor’s discretion. Surgery will not be performed on any pet with a high grade heart murmur.
Owners Initials *
If in the course of treatment, a condition is discovered which requires medical attention or an additional procedure, such as hernia repair, the administration of IV fluids, the attending veterinarian may, in his/her absolute discretion, perform such procedure. I consent to these procedures and agree to pay reasonable additional charges if any.
I further understand that as long as, in the opinion of the attending veterinarian, the animal is an acceptable surgical candidate, sterilization procedures will be performed. I understand that the attending doctor can refuse to perform any procedure on any animal for any reason.
If my pet is pregnant, RMAA may still spay her at the veterinarian's discretion, terminate the pregnancy, and dispose of any content of fetal sacs.
Owners Initials *
I agree that RMAA is not responsible for any further treatment, after care, or emergencies beyond today’s described procedures. I agree that I will be financially responsible for any post-operative medical treatment relating to this procedure or any unrelated medical problems of my animal.
Owners Initials *
Has this animal received any medications in the last month (include flea and heartworm medication): *
Does this animal have any health conditions that we should know about? *
By checking this box I am certifying my pet has not bitten anyone in the last 30 days. *
By checking this box I am agreeing to the terms set out above. *
May we use a picture of your cat for our newsletter or facebook
Electronic Signature *
Emergency Phone Number the Day of Surgery *
I, the undersigned, being of legal age and responsible for the animal, have read and understand this entire page and have the authority to grant Rozzie May Animal Alliance (RMAA) and it's staff members, volunteers, and/or agents my consent to receive, transport, prescribe for, treat, and preform sterilization surgery (procedure), vaccinations, flea treatment on the animal named above and provide other related medical care